Creatinine steadily on rise

[p_bala]

Dear Sir,
   I after almost 8months of itching finally a blockage in the anterior duct is detected along with the posterior one. 3months back ERCP was done and liver engymes are perfectly normal.

But due to high dose of tacrolimus the creatinine is gratually on rise(it is now around 1.9). My doc is trying to reduce the dose. Since I was on tacrolimus only(as Mycophenolate causes TLC to go down in two occasion), sirolimus 1mg is started along with reduced tacrolimus(2mg BD, Tac level ~4.5). But the creatinine is still high(1.8). It seems some side effect of Sirolimus is also coming as the TLC is 3400 and platelet is 80,000.
What do you suggest to bring creatinine under control?
What is the way to determine the exact required dose of tacrolimus?

Regards,
p_bala

[Thomas D Schiano, MD]

minimizing the prograf in favor of either rapa or cellcept is the way to go along with scrupulous control of any high blood pressure of diabetes.  you must avoid all NSAIDS such as ibuprofen

[p_bala]

Dear Sir,
   Tac level is in the range of 4-4.5 and sirolimus dose is 1mg OD(sirolimus is not being increased, because TLC gone down to 3400 after Sirolimus has been introduced).
Do you suggest for further reduction of tacrolimus(present dose is 2mg BD)?

Regards,

[Thomas D Schiano, MD]

i wouldnt lower the tacrolimus dose further